750CanyonDr_75019_64158 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Name of PWS:Coppell
PWS I.D.:0570040
Address:816 S.Coppell Road
Coppell,Texas 75019
Phone:972-462-5150
Contact Person:Jerry Davis
Catalog No: TXTCOP-42982
Test Date: 2/8/2019
Result: Passed
Reason for Test: Existing
Account Name : Polk Mechanical
Address of Assembly : 750 Canyon Dr
Address Type : Commercial
Inspection
The backflow prevention assembly detailed below has been tested as required by TCEQ regulations and is certified to be operating within
acceptable parameters.
Type of Assembly :Double Check Valve Frequency :Annual What does this serve? FireLine
Manufacturer :Wilkins Model No :350DA Size :8 Serial No :42940
Location At:North vault
Is the assembly installed in accordance with manufacturer recommendations and/or local codes?Yes
Is the assembly installed on a non-potable water supply (auxiliary)?No
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Initial Test
Date:2/8/2019
Time:12:00 PM
Held at 2.6 psid
Closed Tight
Leaked
Held at 3 psid
Closed Tight
Leaked
Opened at psid
Did not open
Opened at psid
Did it fully open
Yes No
Held at psid
Leaked
Repairs and Materials
Used **
Test After Repair
Date:
Time:
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Opened at psid Held at psid
***2nd check:numeric reading required for DCVA only
Test gauge used: Potable Make: Apollo Model: 40-200-TK5U Serial No.: 04142872
Date Tested for Accuracy: 8/17/2018
Remarks :passed
Firm Name : Ideal Fire &Security,LLC Licensed Tester : Tony Jacquez
Firm Address : 6913 Camp Bowie Blvd.Suite 181 BPAT License # : BP0017402
Firm Phone No : 817-222-1283 License Expiration Date : 06/29/2019
The above is certified to be true at the time of testing.
* Test Records must be kept for at least three years.[30 TAC §290.46(B)]
** Use only manufacturer's replacement parts.